You wanna make sure that you’re documenting these accounts clearly.
This is very challenging history to diagnose sometimes or to document
because you wanna make sure that you’re documenting restraints
or potentially involuntary commitment to the hospital.
You wanna know especially if you’re gonna involuntarily commit your patient,
how is the patient at risk of harm to themselves or others?
You wanna talk with collaterals.
Again, you wanna involve family members, friends,
therapists, anyone else who many know the patient better
who might be able to give you additional information.
And additionally, you wanna make sure that you document clearly a follow-up plan.
So these are all things
that you wanna make sure that you’re writing down in the medical record.
Disposition for these patients, we have a few options.
So the first is admission to a psychiatric hospital.
Now, patients definitely do get admitted to the psychiatric hospital
If we’re concerned that they’re at risk of harming themselves or harming other people,
if we’re worried about their safety, if we think that they’re very depressed
and they would benefit from this. But in the literature,
there’s actually debatable efficacy for an inpatient psychiatric admission
and some people say that close outpatient follow-up
may have better or similar outcomes actually.
Now again, that’s not to say that patients shouldn’t be admitted to the psychiatric hospital.
We just wanna make sure that we’re selecting the appropriate patients to go there.
Another option is involuntary or emergency commitment.
This varies state by state, so there’s different laws in each state,
and the time in which you can hold someone is between 72 hours and 15 days.
Sometimes these involuntary commitments are started by the physician
who’s caring for the patient, but sometimes and in certain states,
a family member, or a concerned friend or individual who sees the patient
can go ahead and create this involuntary commitment for the patient.
And then, some patients are gonna be able to go home after evaluation.
One thing you wanna be sure is that that patient can have close follow-up
with a mental health professional.
Ideally, they’re gonna be seen within 72 hours.
We wanna make sure we provide resources and patient education.
And we wanna also discuss with family and the patient,
temporary removal of guns or firearms, if they’re located at home.
So in conclusion, suicidality is a common presenting complaint
to the Emergency Department.
Risk factors include access to firearms, substance abuse, or a mental health history.
Elderly white males are the highest risk group
but are by no means the only people who are involved here.
So in the Emergency Department,
our main goals of care include identification of acute medical illness
as well as patient and staff safety.
Disposition decisions can be very complicated here.
If discharged, patients should ideally have follow-up
with a mental health provider within 24 hours
and you also wanna be sure that your patient
has good resources and good return instructions to the Emergency Department.